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Reading ICAI’s review of DFID WASH results

Suvojit Chattopadhyay's picture

The Independent Commission for Aid Impact (ICAI), UK’s aid watch dog, today, released its review of DFID’s programming and results in water sanitation and hygiene (WASH). In this impact review, they take a close look at the results DFID reported in its 2015 Annual Report; results that cost £ 713 million between 2010 – 2014. 

Do read the full report here.

Some thoughts on the areas of concern in the report:

  • The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
  • Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
  • The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
  • ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.

Blog post of the month: The 2016 Multidimensional Poverty Index was launched last week. What does it say?

Duncan Green's picture

Each month People, Spaces, Deliberation shares the blog post that generated the most interest and discussion. In June 2016, the featured blog post is "The 2016 Multidimensional Poverty Index was launched last week. What does it say?" by Duncan Green.


This is at the geeky, number-crunching end of my spectrum, but I think it’s worth a look (and anyway, they asked nicely). The 2016 Multi-Dimensional Poverty Indexwas published yesterday. It now covers 102 countries in total, including 75 per cent of the world’s population, or 5.2 billion people. Of this proportion, 30 per cent of people (1.6 billion) are identified as multidimensionally poor.

The Global MPI has 3 dimensions and 10 indicators (for details see here and the graphic, right). A person is identified as multidimensionally poor (or ‘MPI poor’) if they are deprived in at least one third of the dimensions. The MPI is calculated by multiplying the incidence of poverty (the percentage of people identified as MPI poor) by the average intensity of poverty across the poor. So it reflects both the share of people in poverty and the degree to which they are deprived.

The MPI increasingly digs down below national level, giving separate results for 962 sub-national regions, which range from having 0% to 100% of people poor (see African map, below). It is also disaggregated by rural-urban areas for nearly all countries as well as by age.

Campaign Art: Salvaging cars and saving lives

Davinia Levy's picture

People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

We all know that organ donations save lives. Some people have to wait months and years to receive the organ they need to stay alive. Sadly, some die before a compatible organ is found for them. According to the US Government, 22 people die each day waiting for an organ in that country alone. Globally, there are some countries that are very generous when it comes to organ donation. Argentina is not one of them.

A metaphor to view this issue is to compare the human body to car parts. If you think about it, in a way we all have a chassis (our skin, muscles and bones), a motor (our heart), we stay well-greased with oil (our blood), and our exhaust pipe is… well you can guess.

To incentivize organ donations in Argentina, a taxi company has been using donated car parts from a scrapyard to fix taxis in their fleet. In exchange, the taxis become visible awareness campaigns for the cause of organ donations.

CUCAIBA: Donor cars

Source: Ad Agency J. Walter Thompson Buenos Aires

The 2016 Multidimensional Poverty Index was launched last week. What does it say?

Duncan Green's picture

This is at the geeky, number-crunching end of my spectrum, but I think it’s worth a look (and anyway, they asked nicely). The 2016 Multi-Dimensional Poverty Index was published yesterday. It now covers 102 countries in total, including 75 per cent of the world’s population, or 5.2 billion people. Of this proportion, 30 per cent of people (1.6 billion) are identified as multidimensionally poor.

The Global MPI has 3 dimensions and 10 indicators (for details see here and the graphic, right). A person is identified as multidimensionally poor (or ‘MPI poor’) if they are deprived in at least one third of the dimensions. The MPI is calculated by multiplying the incidence of poverty (the percentage of people identified as MPI poor) by the average intensity of poverty across the poor. So it reflects both the share of people in poverty and the degree to which they are deprived.

The MPI increasingly digs down below national level, giving separate results for 962 sub-national regions, which range from having 0% to 100% of people poor (see African map, below). It is also disaggregated by rural-urban areas for nearly all countries as well as by age.

Campaign Art: Soap that helps early detection of cancer

Davinia Levy's picture
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

If you think about your community (family, friends, colleagues, etc), you probably know someone who has or has had breast cancer. According to the World Cancer Research Fund International, in 2012, breast cancer was the second most common cancer, with about 1.7 million new cases registered.
 
The good news, if any, is that breast cancer has a very high survival rates (of over 90%) when detected and treated at an early stage. A good way to detect cancer early is to perform routine self-exams to search for any lumps or changes in the breast area. A recommended time to do these self-exams is when we are naked and alone – and these conditions are met when we are in the shower.

To incentivize self-exams amongst the local population in Puerto Rico, HIMA San Pablo – a network of hospitals – came up with this public health awareness campaign. They distributed soap with a reminder carved in each soap bar and with waterproof instructions to correctly perform self-examinations in the shower.
 
The Life Soap

Tackling cholera through radio in Kenya

BBC Media Action's picture

David Njuguna, a mentor for BBC Media Action Kenya, looks at how a volunteer-run local radio station is helping prevent cholera in Kenya.

Kamadi, presenter at Mtaani Radio in Nairobi, Kenya
Kamadi, presenter at Mtaani Radio in
Nairobi, Kenya

Last year Kenya was facing a devastating cholera outbreak. It started in the capital, Nairobi and by June 2015, a total of 4,937 cases and 97 deaths had been reported nationally.

According to public health officials, the spread of cholera in Nairobi particularly affected people living in slums. Frequent bursting of sewer lines, poor sanitation facilities and heavy rains played a major role in the outbreak. Poor hygiene practices – such as not washing hands before eating or preparing food – also contributed to the spread of disease. The outbreak eventually petered out, but the environment and practices that contributed to the spread of cholera continue to pose a threat.

In a quiet courtyard, away from the hustle and bustle of Nairobi’s Kawangware slum, a community radio station was planning a response.

Local radio

Mtaani Radio, run by a team of volunteers, was a hive of activity when I walked into their studio last week. They were recording content for ‘WASH Wednesdays’, a show looking at ways listeners can improve their health and hygiene. The show, reaching over 100,000 people in the Kawangware community, was just about to start.

What can historical success teach us about tackling sanitation and hygiene?

Duncan Green's picture

Ooh good, another ‘lessons of history’ research piece. Check out the excellent new WaterAid report: Achieving total sanitation and hygiene coverage within a generation – lessons from East Asia.

The paper summarizes the findings of four country case studies: Singapore, South Korea, Malaysia and Thailand, all of which produced ‘rapid and remarkable results in delivering total sanitation coverage in their formative stages as nation states’. I can certainly vouch for Singapore – I spent 3 years there as a child in the late 60s. Whenever the rains came, the main roads flooded, turning the city into an insanitary swamp. Not any longer.

The paper concludes: ‘Although their initial conditions were very different from those currently found in ‘fragile’ and ‘least-developed’ countries in Africa and South Asia, some useful conclusions can be used to inform discussions on development of strategic approaches to delivering sanitation for all:

Blog post of the month: Six lessons I learnt while trying to reach 10 million women in India with life-saving health information

BBC Media Action's picture

Each month People, Spaces, Deliberation shares the blog post that generated the most interest and discussion. In March 2016, the featured blog post is "Six lessons I learnt while trying to reach 10 million women in India with life-saving health information" by Priyanka Dutt.

Kilkari mobile messagingLast month, the Government of India launched a nationwide mobile health (mHealth) program designed by BBC Media Action, the BBC’s international development charity. The aim - to train 1 million community health workers and help nearly 10 million new and expecting mothers in India make healthier choices and lead longer, healthier lives.
 
Mobile Academy is an anytime, anywhere audio training course, delivered via mobile phone, designed to refresh the knowledge and strengthen the communication skills of community health workers. The objective is to enable the nation’s nearly one million health workers to more effectively persuade families to lead healthier lives.
 
Kilkari  (a baby’s gurgle) service delivers free, weekly, time-appropriate audio messages about pregnancy, childbirth, and childcare directly to the mobile phones of mothers and other family members from the second trimester of pregnancy until the child is one year old.

These services were originally designed for use in Bihar in North India, where BBC Media Action, in partnership with the state government works to improve demand for health services, improve social norms and impact health outcomes for mothers and children. Read more.

Mobile Academy and Kilkari leverage the massive penetration of mobile phones to reach the most marginalized, hardest-to-reach communities in India. These are communities where getting pregnant and having babies can be 24 times more life-threatening than giving birth in the United Kingdom!
 
The statistics are pretty stark. Globally, every five minutes, three women die from complications related to pregnancy or childbirth, while 60 others will be left with debilitating injuries. Of these deaths, India accounts for the greatest number of women dying – over 150 every day. But we know how many of these health risks that pregnant women and their newborns face are preventable.

Campaign Art: Raising the Volume to Fight Tuberculosis

Davinia Levy's picture
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

Tuberculosis is the #1 infectious disease killer in the world.  It kills more people annually than HIV/AIDS. Tuberculosis (TB) is caused by bacteria that most often affect the lungs. TB is spread from person to person through the air (coughing, sneezing, etc). Each year, almost 10 million people develop TB, at least 1 million of which are children.

Tuberculosis is curable and preventable. However, since it’s most affected areas are in developing countries, international assistance and action is critical to help control, contain and eliminate this disease.  To raise awareness about TB, especially its effect on children, the campaign “Louder than TB” produced this short - yet hard to watch - video:
 
Louder than TB

Source: TB Alliance
 

Six lessons I learnt while trying to reach 10 million women in India with life-saving health information

BBC Media Action's picture

Priyanka Dutt shares what she has learned while implementing a mobile health program for women in India.

Kilkari mobile messagingLast month, the Government of India launched a nationwide mobile health (mHealth) program designed by BBC Media Action, the BBC’s international development charity. The aim - to train 1 million community health workers and help nearly 10 million new and expecting mothers in India make healthier choices and lead longer, healthier lives.
 
Mobile Academy is an anytime, anywhere audio training course, delivered via mobile phone, designed to refresh the knowledge and strengthen the communication skills of community health workers. The objective is to enable the nation’s nearly one million health workers to more effectively persuade families to lead healthier lives.
 
Kilkari  (a baby’s gurgle) service delivers free, weekly, time-appropriate audio messages about pregnancy, childbirth, and childcare directly to the mobile phones of mothers and other family members from the second trimester of pregnancy until the child is one year old.

These services were originally designed for use in Bihar in North India, where BBC Media Action, in partnership with the state government works to improve demand for health services, improve social norms and impact health outcomes for mothers and children. Read more.

Mobile Academy and Kilkari leverage the massive penetration of mobile phones to reach the most marginalized, hardest-to-reach communities in India. These are communities where getting pregnant and having babies can be 24 times more life-threatening than giving birth in the United Kingdom!
 
The statistics are pretty stark. Globally, every five minutes, three women die from complications related to pregnancy or childbirth, while 60 others will be left with debilitating injuries. Of these deaths, India accounts for the greatest number of women dying – over 150 every day. But we know how many of these health risks that pregnant women and their newborns face are preventable.

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